A client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant heart sounds, and is anxious and restless. After Initiating oxygen therapy and IV hydration, which intervention is most important for the nurse to implement?

Monitor oxygen saturation (SpO2) via continuous pulse oximetry.

Observe neck for jugular vein distention.

Notify healthcare provider to prepare for pericardiocentesis.

Assess for paradoxical blood pressure.

Answer and Explanation

The Correct Answer is C

A. Monitoring oxygen saturation is important but secondary to addressing the immediate cause of the cardiac tamponade.

B. Observing for jugular vein distention is relevant but not the priority compared to directly addressing the tamponade.

C. Notifying the healthcare provider to prepare for pericardiocentesis is the most critical intervention. Cardiac tamponade requires immediate decompression to relieve pressure on the heart and restore normal function.

D. Assessing for paradoxical blood pressure can provide additional information but does not address the immediate need for intervention.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Explanation

Bladder retention: The client reports increased urinary urgency and frequency, waking at night to void, and instances of incontinence. These symptoms are consistent with bladder retention, where the bladder does not empty completely, often seen in benign prostatic hyperplasia (BPH).

Overflow incontinence: This type of incontinence occurs when the bladder is full, and small amounts of urine leak out due to an inability to empty the bladder properly, commonly associated with BPH.

A. Fresh fruits. B. Yogurt or buttermilk. C. Green leafy vegetables. D. Avocados and cheese.

Correct Answer is B

Explanation

A. Fresh fruits are generally healthy but do not specifically address the need for probiotics or managing potential side effects of antibiotics.

B. Yogurt or buttermilk are good choices as they contain probiotics that can help maintain or restore normal gut flora, which can be disrupted by antibiotics like cefdinir.

C. Green leafy vegetables are nutritious but do not address the need for probiotics.

D. Avocados and cheese are nutritious but do not specifically support gut health or counteract antibiotic-related disruptions.

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A client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant heart sounds, and is anxious and restless. After Initiating oxygen therapy and IV hydration, which intervention is most important for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Explanation

The healthcare provider prescribes the antibiotic cefdinir 300 mg PO every 12 hours for a client with a postoperative wound infection. Which foods should the nurse encourage this client to eat?

Correct Answer is B

Explanation

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